by LAUREN MUSCARELLA

When it comes to beating breast cancer, the conventional wisdom of early detection and “prevention is better than cure” is uncontested. Early detection through mammograms involving low-voltage X-rays of the breast, have long been championed by trusted organizations as the best defense against the disease.

The National Cancer Institute recommends that women who are at normal risk of breast cancer should begin mammography screening at age 40. The NCI’s recommendation is consistent with that of the American Cancer Society and the American Medial Association, which say that mammograms save lives by detecting breast cancer early. Currently, the United States is the only country that recommends mammography for premenopausal women and women under 50.

But some researchers say mammography screening may do more harm than good for women in their 40s who are not at high risk of getting breast cancer.

“Mammography for screening, not for diagnosis, when an abnormality is present, does more harm than good for women in their 40s,” says Dr. Cornelia Baines, a professor and researcher for the department of public health services at the University of Toronto, who has done extensive research on mammography and is considered an expert in the field.

Baines says breast cancer is a disease that affects older women. Mammograms are not as effective for younger women who still have dense breast tissue, and it is harmful to expose menstruating women to radiation, she said. Bains, a Canadian resident, says that “screening mammograms should begin in women in their 50s, and I am glad I live in a country where that is the general policy.”

Dr. Steven Goodman, a professor and researcher at the School of Public Health at Johns Hopkins University in Baltimore, Md., agrees, saying that between three to five women will receive at least one false positive diagnosis after 10 mammograms.

“The two downsides to mammograms are false positives and finding ‘pseudo disease,’” he says. Pseudo diseases are small breast tumors that may or may not spread into cancer. Goodman says the problem is that there is no way of knowing whether it will grow, so it will most likly end in unneccessary lumpectomy or mastectomy.

Goodman says these false alarms also tend to generate additional tests and significant concern. Citing recent analysis published in the Annals of Internal Medicine, he says the reduction in death rate for women in their 40s who start screening is very small: about one in every 3000 women screened over a 10-year follow-up.

For women in their 40s who have an average or below-average breast cancer risk, Goodman says the risks associated with mammograms may outweigh the benefits. However, for most women who are at higher risk of breast cancer, Goodman says the benefits of early detection through mammograms outweigh the risks.

“The problem with mammograms in young people is that the breast tends to be radiographically more dense, and it is generally much more difficult to see a cancer if it is there, and even easier to miscall a benign lesion as cancer,” says Goodman.

Computer-Aided Detection (CAD) is a tool designed to help radiologists read mammograms more accurately. However, a recent study endorsed by the National Institutes of Health found that CAD may not help diagnosis.

CAD is used at about 10 percent of mammogram centers across the country, and the researchers found that women who underwent mammography screening at centers using CAD devices were more likely to be told their mammogram was abnormal and undergo biopsies to rule out breast cancer. The CAD software highlights suspicious areas for radiologists to review, but few studies were done before the U.S. Food and Drug Administration approved it in 1998. Researchers estimate that for “every additional woman diagnosed with breast cancer on the basis of CAD, 156 women are falsely recalled for more tests and 14 have unnecessary biopsies.”

Biopsies have a hidden danger, said Dr. Ralph W. Moss, who has done extensive research on biopsies and mammograms. “It is well-known that surgical procedures performed in the vicinity of a tumor are capable of causing dissemination of cancer,” he said.

Moss wrote The Moss Report, a study of over 200 types of cancers and their treatments, which explains that biopsies are capable of inadvertently spreading the disease.

In addition to false diagnosis, Moss says there is also the exposure to low doses of radiation. “Over a period of 10 years, a premenopausal woman undergoing annual mammograms receives almost half the dose of radiation that was measurable within a mile of the Hiroshima bomb,” he wrote.

In response to the debate on the efficacy of early detection through mammograms for women under 40, the American College of Physicians issued mammography screening guidelines in April that addressed both sides of the debate. The ACP acknowledges that the risks associated with screening mammography include false-positive results, unnecessary biopsies and harmful radiation exposure.

According to evidence studied by the ACP, the risk of breast cancer is not significant in women between the ages of 40 and 49. Thus, the benefits of screening mammography are not applicable in women in this age group. The ACP therefore, recommends that women age 40 to 49 work closely with their physicians to determine their level of risk and the possible benefits and harms of screening mammography.

“It is important to tailor the decision of screening mammography by discussing the benefits and risks with a woman, addressing her concerns, and making it a joint decision between her and her physician,” said Dr. Amir Qaseem, a senior medical associate at ACP.

“If anything, young women should not worry about breaat cancer until they are in their 50s, because they are at a very low risk,” said Dr. Baines. The fear that organizations have instilled in women is misleding. It would be smarter to regularly practice breast self-examinations, while exercising regularly, eating right and not smoking, all which have been clinically proven to reduce a women’s risk of breast cancer.